Water Exchange (WE) Significantly Reduces the Need for Abdominal Compression during Colonoscopy: Prospective Comparison with Air Insufflation (AI) and Water Immersion (WI)

Background: Abdominal compression (Ac) to facilitate scope advancement may cause hand injury in endoscopy assistants. To minimize insertion discomfort, 85% vs. 57% required Ac when air insufflation (AI) and water exchange (We) were compared in unsedated colonoscopy. Aim: To compare the need for abdominal compression during colonoscopy using AI, We and water immersion (WI). We hypothesize that We significantly reduces need for Ac compared to AI and WI. Methods: A performance improvement project involved 8 endoscopists using AI (n=2), WI (n=3) and We (n=3) for sedated colonoscopy. (AI): conventional colonoscopy with air; (WI): water was infused to facilitate scope insertion and was removed mainly during scope withdrawal; (We): water was infused and removed predominantly on scope insertion, air button was off till cecum was reached and air was used on scope withdrawal. consecutive patients were scheduled with endoscopists and colonoscopy was performed with technique based on endoscopists’ preference. With insertion difficulty abdominal compression was applied by the assistant and/or patient was repositioned to facilitate scope advancement. Results: 259 patients were included, 6 were excluded due to poor bowel prep (n=2) and prior colonic resection (n=4). Abdominal compression and/or position change, and procedural outcomes were compared. There was a significant difference between We vs. WI and AI colonoscopy in need for abdominal compression but no significant difference between WI and AI. Conclusion: Water exchange colonoscopy required significantly less abdominal compression compared to WI or AI method and may potentially minimize risk of hand injury among endoscopy assistants.